LIBRARY OF CONGRESS. 



Shelf... 



UNITED STATES OF AMERICA. 



PREVENTION OF YELLOW FEVER 



IN 



FLORIDA AND THE SOUTH. 



VAN BIBBER. 






/ 



PRETENTION OF YELLOW FEVER 



TN 



FLORIDA AND THE SOUTH. 



A Paper Read Before the Baltimore Academy of Medicine, 

December 4, 1888. 



BY 



W. C:%n Bibber, A. M., M. D., 



Member of the Medical and Chirurgical Faculty of Maryland, 
Member of the American Medical Association, Member 
of the American Public Health Association, 
the American Climatological Society, the 
American Social Science Associa- 
tion, Ex-President of the 
Baltimore Academy 
of Medicine, 
etc. 








BALTIMORE, MD. 

Journal Publishing Co. Print. 

18§9. 






a° 



The yellow fever was introduced into Key West, Florida, from 
Havana, during the Summer of 1887; from Key West into 
Jacksonville, Florida, in August, 1888; from Jacksonville into 
Decatur, Alabama, and other points, in September, 1888; and 
in consequence of this an extensive and ruinous panic spread 
throughout the southern and south-western states during the 
latter part of the summer of 1888. See the reports of the 
Boards of Health of the different states, particularly of 
Tennessee, and especially, Bulletin No. 3 of that Board of 
Health, dated Nashville, Tenn., October 15th, 1888. 



TO 

HON. JOHN T. LESLEY, OF TAMPA, 

WHOSE EXERTIONS FOR THE PROSPERITY 

AND ADVANCEMENT OF FLORIDA, HIS NATIVE STATE, 

ARE WELL KNOWN, AND APPRECIATED BY 

HIS FELLOW CITIZENS, 

THIS PAMPHLET IS RESPECTFULLY INSCRIBED. 



Let Those do the Woek who Know How. 



THE PREVENTION OF YELLOW FEVER IN 
FLORIDA AND THE SOUTH. 



The presence of yellow fever in Florida is certainly a serious 
matter; and the occurrence of an epidemic at such a centre as 
Jacksonville, with out breaks atmore northern localities, is a wide- 
spread calamity. It is not alone for the loss of life and on 
account of the great sufferings endured in the infected districts 
that it is to be dreaded ; but so long as the disease does not seem 
to be perfectly understood by the public, and all the conditions 
which favor or prevent its extension are not definitely settled, no 
one can tell what proportions it may not at some time assume. 
Although I am not an alarmist, yet it seems to me not unreason- 
able to say, if the same course of management continues to be 
pursued as existed last summer, it might at some time even 
become a national calamity. At the present time, and under the 
present methods, a single case at the beginning of hot weather 
suffices to throw a whole community into a paroxysm of terror. 

This should not be the case, with the existing knowledge ; and 
I have for a long time been impressed with the belief that it 
would be better to change the manner which has been pursued 
for more than half a century, of presenting the disease to the 
public. If such a change should happily be made, it might alter 
the entire procedures in the matter ; and as the results of the 



— 6 — 

methods which have been in use for so long a time have not yet 
been successful in subduing the disease, it would seem well to 
try something which might with more certainty have this effect. 
I would suggest, therefore, to change the points of discussion 
from the contagiou. the transportation and quarantine of yellow 
fever, to the yet more practicable subject of its entire prevention 
at home, and its immediate extinction if introduced from abroad. 
It is plain, if the disease can be prevented, the other points con- 
nected with it are cancelled, and are of no public importance. 

It is a physician's duty to consider possibilities as well as 
probabilities ; and, looking at the records of the past, we can say 
to-day, that it is the belief of these who have studied the subject, 
and are capable of giving an opinion, that yellow fever is a pre- 
ventible disease. If this is correct, it is of the first importance 
to Florida to act promptly upon such knowledge, provided the 
citizens of the State will undertake to carry out those measures of 
prevention which may be deemed most effective. The State of 
Florida has more than ordinary advantages in carrying out any 
preventive measures its citizens may wish to adopt, because the 
entire peninsula is under one legislative government, and there 
is no very large commercial city within its boundaries. 

Before proceeding to describe any definite plans for the pre- 
vention of yellow fever, and for the purpose of leading up to the 
subject before us, something should first be said concerning the 
fever itself, and of the methods which have heretofore been used 
in the public management of the disease, both before it becomes 
epidemic, as well as during and after its prevalence. 

Yellow fever is a disease so well marked, so deadly, so different 
from all other diseases, that no one, whether a physician or not, 
can avoid being attracted by almost anything which may be 
written about it, and this may be one of the reasons why its liter- 



— -7— 

ature is so immense. I have before me a catalogue of several 
hundred volumes treating of it; and the number in the library of 
the Surgeon General's office at Washington runs up into the 
thousands. This fact of itself is sufficient to prove that the 
disease has not been slighted by the medical faculty, or, that its 
importance has not been recognized ; yet a research into this 
voluminous literature will show that up to this time no definite 
conclusions have been reached concerning its origin, contagion, 
infection, transportation and quarantine. These feubjects have 
been captivating to writers because they involve many abstract 
points and much varied learning ; but the subject of prevention 
is more practical, and may be dealt with to advantage, since we 
now have knowledge which brings us nearer to this point than we 
ever were before. 

The methods which have been heretofore used for the public 
management of the disease are briefly as follows : — 

When the hot weather sets in, the more prudent and observant 
citizens, seeing the neglected condition of their town, expect an 
increase of sickness, and naturally, from experience, think of an 
outbreak of yellow fever. They call public attention to this 
dangerous state of affairs, but as there is generally no sinking 
fund, or unappropriated surplus that can be drawn upou for 
thorough measures, nothing effective is done. A few of the most 
flagrant and offensive nuisances are abated, and the citzens are 
notified to keep their premises in good order; and that is about 
all. Those who can afford it send away their families for the 
summer, and go themselves, if their affairs permit; and while 
they are gone, the fever appears. Then comes a flight of all who 
can get away, and those who cannot leave, begin at last to see the 
danger of the "foci," as they are called, and try to remove them. 
It is then announced that yellow fever is epidemic, and the town 



being quarantined against abroad, the authorities quarantine 
persons coming from infected places. In this way the tow-n or 
city becomes isolated and the inhabitants seek assistance. In 
this country the Howard Association sends acclimated nurses; 
physicians volunteer ; and business friends from other cities send 
money. Thus the people, shut up within their own limits, work 
and clean, and pass the wretched existence of a plague-stricken 
city or community — praying for cold weather or frost, or for 
some end to the pestilence by disinfection or limitation. As soon 
as the end comes they count up losses and search in every direc- 
tion for the origin of the trouble. Each one has his own theory, 
and all relate their personal stories of exertions made during the 
epidemic. Thus some pride is taken in the success, and the belief 
spreads, that what was done towards cleaning the town was a 
necessary experience, and therefore, in the end, rather a blessing 
to the survivors. In this spirit business is resumed, the quaran- 
tines are abolished — by degrees the past is forgotten, and in the 
course of time the "foci" are allowed to collect again, and sooner 
or later the same experience is repeat jd. 

Such methods as these will not be sufficient for the interests of 
Florida. In former years they have been adopted by New Orleans, 
Savannah, Charleston and other seaports in our own and other 
countries where frost does come, and where cleaning, although 
badly done, does avail for the time being, because their situations 
as seaports have attractions for commerce which brings back their 
trade to them without much trouble. But in Florida, during 
some seasons, and in some places, frost comes very late, if at all, 
and the commerce of that State is not in such articles as to insure 
its return. For Florida some other plan is indispensable. The 
methods mentioned did not suit Memphis, Tennessee ; and there 
other efforts directed to prevention were made, with encouraging 



_9— 

success. But those methods, which consist principally of systems 
of sewerage, are not applicable where the lands are low and flat, 
as in Florida; and it is to propose a method, or combination of 
methods, suited to that State, which is the object of this paper. 
Before proceeding further it may be well to show how yellow 
fever will not be prevented in Florida. The followiDg extract is 
taken from "Science" October 26th, 1888, p. 197. 

"YELLOW FEVER AXD BAD SANITATION." 

" Surgeon General Hamilton has just published the reports of 
several of the government inspectors who were detailed to visit the 
cities and towns of Florida, to ascertain their sanitary condition, 
and whether yellow fever prevailed in them or not. Among these 
reports is that of Dr. J. L. Posey upon a visit to Macclenny, a 
small town of about six hundred inhabitants, in Baker County, 
in which the fever was epidemic. Here is what he says about the 
sanitary condition of the place : — 

" The general appearance of the town, which consists of per- 
haps a hundred stores and dwellings scattered over a rather large 
area, indicated a very wretched sanitary condition. The streets 
along the railroad track, as well as others, were covered with 
heaps of decaying saw-dust, and garbage of every description 
spread over them, drains obstructed, and open lots overgrown 
with weeds and rank vegetation. The floors and platforms of 
the depot-buildings, passenger and telegraph offices, and their 
vicinity, were covered with lime, which had recently been thrown 
broadcast. A further stroll through the town revealed a similar 
deplorable sanitary state — the steps and front galleries, the 
porches and premises of residences, lavishly sprinkled with lime, 
and the yards filled with accumulated garbage. No organized 
measures have been adopted by the local health authorities to 



—10— 

even ameliorate, much less correct, this unsanitary state of their 
town. 

i( The site of the town is a low flat, sandy plateau, without 
sufficient elevation to give effective drainage ; the surrounding 
pine forests being interspersed with a series of marshes and 
alluvial basins. No attention had been given to the removal of 
excreta or their proper disinfection. The water-supply is gener- 
ally obtained from wells at a depth of fifteen or twenty feet, and 
is of a quality which I consider unwholesome, having experienced 
personally its disagreeable effects. The atmospheric condition 
resulting from such foul surroundings was fully prepared to 
propagate the infectious material, which had been already intro- 
duced into the town, and had been gradually developed since the 
1st of August. 

"I went from house to house, and found the sick and djing 
huddled together in small rooms, with windows and doors closed, 
the floors sprinkled with chloride of lime, carbolic acid, and a 
variety of other disinfectants. The oppressive odor of disinfect- 
ants mingling with the close atmosphere of the sick rooms, laden 
with the emanations from the excreta and ejecta of the patients, 
together with the dreadful visages of the dying, was shocking to 
every sense, and the scene well calculated to appal the stoutest 
hearts. I have seldom witnessed a more pitiable and melancholy 
sight than that presented to my view in my house-to-house in- 
spection through this desolate scourge-swept town. As I returned 
to the hotel in the evening, 1 met many whose pale, wan features, 
languid air and step marked them as convalescents from the 
disease, and others, who, with anxious look, approached me, and 
in whispered tones asked to know my opinion of the prevailing 
fever. I told them that they must escape with the rising sun, 
or, remaining, fall victims to yellow-fever. 



—11— 

"A late report shows that there have been 189 eases out of an 
actual population remaining of 195,, the deaths being 21 whites. 
Of the above number, 160 were whites and 29 colored. There 
are uow sick 11 whites and 8 colored/'' 

"Dr. Posey himself contracted the yellow fever at Macclenny 
but has since recovered." 

"Comment upon such a report as this is unnecessary. Yellow 
fever is a disease that seeks filth and bad sanitary conditions, and 
wherever it finds these, and an unacclimated population, it is 
certain to become epidemic. Its whole history in this country 
proves this ; and especially was this illustrated in the terrible 
experiences of Galveston about twenty years ago, of Shreveport a 
few years later, and more recently at Memphis. Yellow fever 
never became epidemic where the sanitary conditions were good, 
although the germs of the disease have frequently been introduced 
into them. It is probable that the sanitation of Jacksonville is much 
better than that of the cities named was at the time the scourge 
swept over them ; and this, it is believed, accounts for the mild 
form of the fever there, and the low rate of mortality." 

The condition of Jacksonville before the breaking out of the 
present epidemic has not been reported upon in detail by the 
government medical inspectors, because, since their arrival in the 
city, their time has been fully taken up with measures of relief. 
But the unsanitary condition of the city, especially along the 
wharves, is so well known, that it may be taken for granted that 
it was not a well kept or a clean city. 

Under date of August 8th, 1888, Passed Assistant Surgeon 
John Guiteras, U. S. M. H. S., wrote to the "Weekly Abstracts 
of Sanitary Eeports " 

<< Two cases of yellow fever discovered this morning — other two 



—12— 

suspicions cases, traceable to same store where the others were 
taken sick. Health authorities are taking active steps in the 
matter. There is a circumscribed « focus ' of infection in one 
block in the city. Two more cases discovered, traceable to same 
centre." 

"August 9th. Two cases found at the city hospital, Three 
other cases discovered to-day. Total, five new cases. We are 
beginning to lose connection with the original 'focus/ " 

Dr. Neal Mitchell, President of the Board of Health of Jack- 
sonville, under date of August 13th, wrote to the " Weekly 
Abstract of Sanitary Reports : " Surgeon General John B. Ham- 
ilton. "New cases four. August 14th. New cases three/'' 
"August 16th. It is too soon to speak of the original origin of 
the epidemic but it is quite probable that the case of McCormick, 
imported from Plant City, was not the first case at Jacksonville. 
Eumors of yellow fever at Jacksonville had been prevalent for 
several weeks/' etc. 

These reports are sufficient to show that towns and cities in the 
condition of Macclenny and Jacksonville are never secure against 
an epidemic of yellow fever, and that this disease will not be pre- 
vented under the present systems of building and quarantine. 

Surgeon General John B. Hamilton, U. S. M. H. S., has 
traced the present epidemic in Florida to its source. It originated 
from a family of emigrants from Havana, who came with their 
household effects into Key West, and there rented apartments 
from a Mr. Baker. Some of the emigrants and the Bakers died 
of yellow fever, and from that beginning every step of the disease 
has been traced. Two fruit smugglers from Key West brought 
infected blankets into Tampa, and from this the disease is traced 
directly along from Tampa to Jacksonville. According to Sur- 






—13— 

geon George H. Sternberg, U. S. A., who investigated the matter, 
the yellow fever was brought into Decatur, Alabama, by a man 
from Jacksonville. It was formerly the habit, and it really 
seemed to be in the nature of our people, to question such evi- 
dence as this, even when given by distinguished experts ; but now 
this is not the case. The manner in which yellow fever is 
brought into a place, and the reason why it spreads in that place, 
are, at present, accepted facts. Florida and New Orleans are 
both in constant easy communication with Havana and Vera 
Cruz. At both these places yellow fever is always present. We 
have no government control over either of these cities. The in- 
troduction of the yellow fever germ may occur at any time. 

Can the disease be prevented, and how? What will be said 
hereafter in this paper will be to show the truth of one proposi- 
tion : three answered questions, and one corollary — These are as 
follows . 

Proposition. In a warm climate, continued cleanliness is the 
best safeguard against yellow fever. 

Question first — Granted an unsanitary condition of a town, 
as Macclenny or Jacksonville, may yellow fever originate sponta- 
neously ? 

Answer. No ! The advanced doctrine is " No germ, no yellow 
fever ;" but inasmuch as the germ has not yet been found, let 
the chance be divided. 

(Question second — Granted an unsanitary condition of a town, 
city or residence, and the importation of yellow fever germ, what 
will be the results ? 

Answer. The result will be yellow fever. 

Question third — Granted a city, town or locality kept contin- 
uously clean, free from all "foci," will yellow fever become 
epidemic, importation, or no importation of germ? 



—14— 

Answer. No ! A place may be made and kept yellow fever 
proof. 

Corollary. An unsanitary condition gives a chance and a half 
for yellow fever. A sanitary condition gives none. 

I know that it is held by many physicians that a rigid quaran- 
tine is the best preventive against yellow fever. That the disease 
is spread by germs is true ; but that it is impossible to prevent 
the introduction of germs from abroad by the present modes of 
quarantine, is fully proved by the past. In the first place it is 
necessary to know what places are to be quarantined against. 
But the germs may be brought from a place where the yellow 
fever is not known to exist. To prevent panic, and the loss of 
trade, the first appearance of the disease is invariably kept secret, 
in the hope that it may be stamped out before it becomes epi- 
demic, and thus the germs may be scattered far and wide before 
any warning is given. Then the system of quarantine now in 
use is so onerous, that all means are tried to evade it; and if but 
one person passes having the germs of disease, all the labor and 
annoyance has been in vain. 

Not that quarantine should be abandoned : keep out the germs 
as far as possible, but provide, that if, desj)ite all precautions, 
they are introduced, they may fall upon clean places where they 
cannot propagate. Treasure quarantine, but make it pleasant 
and not hateful. 

By what method can continued cleanliness be most easily main- 
tained in a city in a warm climate? In the " Annals of Hjgiene/' 
March 1st, 1887, in a paper upon " House and Yard Ventilation ,J 
the writer says : 

"I am personally quite familiar with this subject from actual 
observation in many of the cities and towns in the States of Penn- 
sylvania, Maryland, Virginia, New York, the Dominion of 






—15— 

Canada, Ohio, Louisiana, Mississippi," and he might have added 
of Florida also. " I know that the yards attached to houses are, 
for the most part, from one hundred to one hundred and fifty 
feet deep, more or less, and are generally surrounded with decay- 
ing board fences eight feet high, and these enclosed yards have 
been, as a rule, the receptacles for all the refuse matters of 
families for a long time. Thus it will readily be seen that they 
affect the air of those dwellings which are near to them as well 
as those to which they are attached." 

" From an eminence in the State of Mississippi, I once beheld 
a beautiful village, which, when seen in the early morning, with 
cluster roses and creepers, covering the roofs of its houses, 
looked like a fairy city of enchantment. Who would have sup- 
posed from the distance at which I stood that it was then the 
abode of a deadly yellow fever pestilence? Its board-screened 
yard?, undrained, level and water-soaked, were filled with things 
offensive and useless, which sheer carelessness had allowed to 
accumulate. Its cemetery was daily being filled from no other 
cause than the neglect of its inhabitants.'" It may be answered 
therefore, that cities and towns, especially in a warm climate, 
which are built and kept in a manner similar to what has been 
described, cannot be said to have come up to the standard of con- 
tinued cleanliness." 

In 1881, a paper was read before the American Pubb'c Health 
Association, at their meeting in Savannah, G-a., under the title 
of " Two Suggestions concerning Healthy Buildings." The first 
suggestion made was "to build houses upon arches or piers in 
low flat grounds. Man has the privilege of building under his 
own control. He must take the earth as he finds it, but one 
style of building may be more healthy, convenient, and salu- 



—16— 

brious in one situation than another. Instead of springing the 
houses out of the ground in low flat situations, it is better to 
interpose a stratum of air between the house and the ground. 
If the house be built well up off the ground, and the earth paved 
beneath it, with no enclosed yards, then continued cleanliness 
could be easily maintained. The surface ventilation of the air 
would be one prominent advantage of this style of building; 
surface drainage, an easy abatement of certain nuisances, with 
consequent increased healthfulness and comfort would be the 
result." 

If Macclenny and Jacksonville and Decatur had been built iu 
this way, and had been kept according to the intention of such 
a style of building, their inhabitants would have been saved 
the recent epidemic. This plan of building the houses well off 
the ground, upon arches, columns or piers, with clean hard 
pavements of brick or concrete underneath and around them, I 
regard with great favor ; it would not only be an improvement 
in itself, but would bring after it many other improvements. 
The objections which have been raised against it are the expense, 
the inconveniences and the danger from violent storms. The 
expense might be a little heavier at first, but if all did it, this 
increased expense would soon be equally distributed — if the 
house cost more to build, the workmen would get more for 
building it, and in this way it would not be considered a burden 
amongst the poor. As to the inconveniences, if there be any, 
they are not worth balancing against the gain, and habit would 
soon make it cease to be felt. The danger from violent storms 
could be overcome by the supports of chimney stacks sprang 
from the ground, or by supporting towers or beams, by means of 
which the houses could be firmly secured, and all clanger averted. 

It is difficult for some minds to divest themselves of the early 



—17— 

bias which they have had from infancy, for building on the 
ground with cellars, and pits and sinks. These are not suited 
to low flat lands in a warm climate ; a sufficient standard of 
cleanliness cannot be maintained in their presence, or where they 
exist. The question as to how high the building-line should be 
off the ground, is an important one, if ever it comes to be con- 
sidered as a matter of statute enactment. 

I have said that quarantine may be made pleasant, and indeed 
attractive, and in this I have only echoed the sentiment of the 
distinguished President of the American Public Health Associa- 
tion in his address at the meeting in Memphis, Tenn. Certainly 
some change in the system of quarantine should now be made, if 
for no other reason, than to prevent a recurrence of such panics, 
confusions, sufferings and scenes, as are so graphically detailed in 
the reports of the Tennessee State Board of Health, Bulletin 
No. 3. With the Members of the Board of Health of this State 
and their agents, it was like fighting for life itself; and those 
engaged in this terrible conflict deserve far more than credit for 
their invaluable services. In a country like ours, such scenes as 
happened during the recent epidemic of yellow fever, should 
never recur. When the disease was announced at Jacksonville, 
consternation spread at once throughout the States of Florida, 
Georgia and Alabama, and extended into the Carolinas, Missis- 
sippi, Louisiana and Arkansas, Texas, Tennessee and Kentucky. 
Assuredly, a wise people, if proper leaders can be found and 
obeyed, should do better in the future than to re-enact such 
scenes. Whilst the recollection of these panics is still fresh in 
the memory, and for those who wish to change the future plan 
of quarantine, let us see both what advantages we possess, and in 
absolute reality, what we have to contend against. 

The advantages may be summed up in this way. We live 



—18— 

amidst a profusion of knowledge, learning and ingenuity ; we 
have upon our side the resources of science, the dictates of 
reason, the results of experience, and the active vigilance of a 
practical, intelligent and energetic people ; with these in our 
favor, what excuse can be given for an onerous quarantine against 
only three diseases, a complete prevention for each of which is 
perfectly well known ? What excuse can be given for not being 
victorious in such a contest without frightening the public ? 

That quarantine may be made attractive, who can doubt. 
But it cannot be done by the plans which an urgent necessity 
compelled the Boards of Health in the States mentioned to adopt 
in their active exertions for the safety of their people. Their 
quarantine had to be done mostly in the railroad cars in which 
passengers were questioned, refused passage to their destinations, 
turned back, frightened, dejected, and oftentimes driven to subter- 
fuges in order to get to their homes and friends, with their 
baggage and letters fumigated, and frequently lost. Quarantine 
cannot be made attractive by these means. 

Let us speak of the attractive quarantine of the future. In 
this, you will see four houses situated at a proper distance from 
each other, in the most accessible point of the State, built and 
appointed in a manner not only to make them most efficient for 
the comfort of the sick and afflicted citizens and strangers, but 
to serve also as schools and models to teach private citizens how 
they can preserve amongst themselves continued cleanliness and 
give no foot-hold to preventible disease. The humblest man in 
the Commonwealth cannot then plead ignorance as to how he 
should and must build his house and manage his domestic affairs, 
so as to preserve his own health, not injure that of his neighbor, 
nor impair the reputation of his State. These four buildings 
should have ample communication with each other and the out- 



—19— 

side world by telegraph, telephone, and what other appliances the 
future may have in store. Then no one who is quarantined will 
feel himself isolated or harshly treated. The visitor from abroad 
and the denizen can alike receive and send messages from and to 
all points. 

In these establishments, all knowledge of yellow fever is to be 
centered ; here the disease can not only be treated, but studied 
under the most favorable circumstances ; and from them, all 
necessary rules for its prevention should emanate. They should 
be under the control of the Board of Health, who should be well 
selected and thoroughly competent, and they should see that 
nothing be wanting to make the establishment as homelike and 
attractive as the most agreeable resort. 

I have said that four houses should be built, although there 
are but three diseases against which we quarantine in this country, 
yellow fever, cholera and small-pox, and this is what we have to 
contend against. For the first two diseases there is the same 
prevention — continued cleanliness — and as for the last, it is com- 
pletely controlled by vaccination and re-vaccination. The fourth 
house should be for the officers of the institution, and for the 
temporary residence of persons who have been brought to the 
quarantine by mistake during periods of excitement. But in 
fact, it is only against the yellow fever germ that quarantine 
would be demanded at present. The arrangements for the other 
two diseases could be managed afterwards. Concerning the 
yellow fever germ, we know three very important things : these 
are, that it does not produce disease in the same individual more 
than once ; it is easily destroyed by cold or frost ; it does not 
spread in a clean place, or amongst a healthy people. To this I 
think may be added, that in a clean place, and in a pure atmos- 



— 20— 

phere, the germ, if unhappily introduced, may now be easily 
sterilized by means of known antiseptics. 

The advantages of such a quarantine establishment cannot be 
easily summed up, for the list is long; but most prominent amongst 
them would be public confidence at home and abroad. Every 
one would know that matters appertaining to this department of 
public health were properly organized, and each citizen would 
understand beforehand exactly what to do under all circum- 
stances, when an epidemic disease was to be dealt with. 

Last year it was estimated that 80,000 strangers visited Florida, 
mainly for the advantages of its climate. If the number is 
diminished this year, it will be in great part owing to the Jackson- 
ville epidemic; and if the State should now lose its prosperity, 
and fail to fill its office amongst the other States, in being the 
delightful, safe and convenient winter refuge for the dwellers in 
more rigorous climates, who may be suffering with pulmonary 
troubles ; it will be on account of permitting the prevalence of an 
entirely preventible disease. But if proper exertions are now made 
to correct the evils engendered by carelessness, which have befallen 
the State, and to secure exemption from their recurrence, it is 
quite certain that enough is known, if only the knowledge be 
properly applied, to establish public confidence in the entire 
practicability of clearing the peninsula of yellow fever, and of 
keeping it perfectly and permanently free from this scourge. 
The advantages for doing this have been already summed up, 
but in addition, it may be said to Florida, keep up continued 
cleanliness in your towns and cities by introducing a different 
and a better style of building, suited to your climate ; erect a 
commanding and model quarantine and make it attractive, so 
that it may stand as a monument of your intentions, and a seal 
to your good faith. Then your sister States will not fear you, 



—21— 

nor your neighboring States get into a panic when your name is 
mentioned. 

On account of the geographical situation of Florida, and by 
virtue of the mission she can fill, it is the interest of all the 
States in the Union to help her at present, for she fairly belongs 
to the afflicted of all the States in common for at least four 
months in the year ; and for this reason it is equitable that they 
should lend a hand to clear this wonderful peninsula from these 
pests to humanity and make it a beautiful garden/ which it is by 
nature, for themselves, and for the world at large, because, in its 
situation between the two seas, and virtually in two zones, there 
is no other land to equal it on the ma»p of the world. It seems a 
pity that we should have such scenes as have recently been pre- 
sented in the South- West on account of something which surely 
can be prevented, which is brought about by less enlightened 
people in other lands, and which is continued in our own country 
by carelessness and neglect. I feel that there is truth in these 
statements and that they will find a response among all intelHgent 
people. 

It may be some stimulus to our citizens to know that the 
people of England and Wales have recently appropriated more 
than £80,000,000 for sanitary purposes alone, aud that they 
consider themselves well repaid for this, in the fact, that they 
have for the time checked the insidious approaches of the cholera- 
germ. The general government with $200,000,000 surplus in 
the Treasury, for the benefit of all the States, might help Florida 
now; and the two together, that is, the general government and 
the State itself, should see that no necessary expense is with-held 
which will give .her fair land a healthy record, and free her inhabi- 
tants from the reproach as a people, and as a State of the Union, 
of being behind hand in learning and energy in not availing 



22 

themselves of what is known in sanitary science, and of failing to 
apply simple and available preventions to a single microscopic 
germ, many of the peculiarities of which are perfectly well-known. 

As if to help in this good purpose, it may be repeated that 
with peculiar boundaries, Florida has an advantage of being under 
one legislative government, so that any preventive measures its 
citizens may wish to adopt, can be secured with great facility. 
It is the largest State east of the Mississippi River and might be 
made, all things considered, the healthiest and most delightful 
winter residence in the world, if only its people will act energeti- 
cally and harmoniously. Its statesmen and men of influence 
should be the leaders in the matter, should explain and convince 
and take initiatory measures themselves. No political question 
can be of one-tenth the importance of this matter of the preven- 
tion of yellow fever. Putting aside all other questions and look- 
ing at the matter from a purely pecuniary point of view, what- 
ever outlay was incurred would be repaid tenfold. We can 
hardly realize what would be the future of this State if it was 
known to be perpetually secured against epidemic disease. 
Invalids, but especially those liable to pulmonary diseases, would 
take refuge there as soon as the cold weather began in more 
rigorous climates ; capitalists and investors would make it their 
home, and develop its boundless resources under their own eyes. 
Population would multiply and wealth increase. The vacant 
lands would be taken up and the Everglades drained. Nature 
has certainly done wonders for this little bit of the tropics, 
attached like a terraced garden to the United States, and it only 
remains for man to remove the one obstacle to her progress by 
wise legislation heartily carried out by her people. 

These are my matured views, after much study, upon this most 
weighty and long debated question. So important do they seem 



—23— 

to me, at least, that even at the risk of tautology, I will recapitu- 
late the leading points. We have already seen that the introduc- 
tion of the yellow fever germ may occur at any time, and that the 
quarantine as now enforced is no absolute safe-guard against it. 
Once introduced, there are but two known modes of preventing it 
from becoming epidemic. These are continued cleanliness and 
isolation combined. If there are any other modes, let them be 
told. It is not hard to accomplish and combine these two modes, 
provided a proper importance should be given to the subjects. 
On the contrary, every one will be better for the machinery by 
which they must necessarily be brought into action. Towns kept 
like Macclenny and the city of Jacksonville must then be reformed 
or disappear, for in them the germ will spread in a warm climate. 

1. It has been proposed in this pajwr to abolish the system of 
board-fenced yards, with pits and sinks ; to pave with hard, clean 
pavements under the houses, which are to be built well up off 
the ground, and to keep the towns clean according to the enforced 
changes which such a style of building will of necessity bring 
about. 

2. To place quarantine prominent, and so alter the way of 
conducting it as to make it attractive, and at the same time, 
through it, to keep a constant vigilance as to the introduction of the 
yellow fever germ and the isolation of the disease. Let the 
quarantine establishments be the great teachers of what is to be 
done, and how to do it. Not every citizen knows how to adopt 
measures of continued cleanliness, but the quarantine officers will 
be ever ready to teach them. Not every citizen can keep up a 
constant vigilance, but the quarantine officers can have this done 
for them. Nothing should be spared to make quarantine worthy 
of public confidence, and this will surely prevent panics. The 
differences which this style of building and living, together with 



--24— 

the teachings which such a quarantine as that which has been 
proposed, would make a salutary change in the manner of life 
throughout the South. This difference amongst the poor would 
almost amount to that between life and death ; certainly it would 
be the difference to the State between prosperity and ruin ; 
between cleanliness and neglect; between beauty and ugliness in 
the appearance of the towns and cities, and might also show 
amongst the white population the difference between clear healthy 
complexions and the reverse. Individually, I would vote for 
these health measures if I were a citizen of Florida, or any of the 
southern states. I would vote for them, with proper modifica- 
tions for climate, in my own city. Personally, I have experi- 
mented with this style of building, by showing an example of it 
on my own premises nearly twenty years ago, and have enjoyed 
its comforts ever since. I believe that no man in the United 
States would this day object to the general government so assist- 
ing their garden of Florida, in its present extremity, as to enable 
its inhabitants to improve the health arrangements of their state, 
in repelling the diseases incident to low flat lands in a warm 
climate, and of making this pensula yellow-fever proof. 

The belief that this can be done is gaining confidence in every 
direction. The dreaded pest has dictated its own terms to an 
intelligent people; who, beyond doubt must sooner or later accept 
its ultimatum — and the sooner the better. The citizens of 
Florida, Louisiana, and of the country generally, are all linked 
together in a common interest for the prevention of yellow fever, 
and of the panics arising from its presence. The way of pre- 
vention has already been shown, and all should be encouraged by 
the good results which can be pointed out by examples 
already within the state. . Amongst others I may refer to medical 
inspector Dr. J. L. Posey's report to the Supervising Surgeon- 



—25— 

General concerning Lake City, Columbia County, Middle Florida, 
published in the "Weekly Abstract of Sanitary Beports," vol. 
iii. Abstract No. 37. September 14th, 1888, which city was 
reported as a model for cleanliness and health. Also Dr. G-. F. 
Hartigan's report to the same authority. Abstract No. 42. 
October 19th, 1888, concerning his inspection of St. Augustine, 
Florida, where, he says, "extraordinary measures were adopted 
to exclude yellow fever ; a double cordon of guards numbering 
300 invests the city night and day, etc., etc./' and although the 
disease was epidemic in two cities not far removed from the 
ancient gates of St. Augustine, yet not a case of yellow fever ap- 
peared within the latter city. The local Board of Health of the city 
of Tampa, in Hillsborough County, Florida, are now about to 
publish their mortuary reports, which, so far as they go, show a 
favorable comparison with the most healthy cities in any climate. 
Again, the public spirited men of Tampa are now erecting, and 
will soon have completed, a hotel built upon the principles advo- 
cated in this paper; elevating the structure high above the 
ground ; keeping it free from all terrene emanations; and paving 
underneath and around it with hard pavement. This, as an ex- 
ample will be valuable in the future. Besides this, the people 
of Jacksonville have done much in the improvement of the 
sanitary condition of their city; and there is now a strong 
public sentiment demanding a State Board of Health, with 
enlarged powers. It is to be hoped that these things, as the 
result of recent experience, will not have the effect of relaxing 
exertions against the future invasion of the insidious enemy, but 
on the contrary that they will encourage the citizens everywhere 
to still further efforts in the same direction, so as to establish a 
general public feeling that the presence of yellow-fever hereafter 



—26— 

may be considered a social or a national disgrace, as well as a 
public calamity. The co-operation which the United States Sur- 
geons have given with the local physicians in Florida anoelse- 
where throughout the South, during the recent trouble, has been 
of great assistance ; and the finishing work now being done by 
the United States Marine Hospital Surgeons, is a fair example to 
show how public confidence can be established under the direction 
of meritorious officers in high position. 



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